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UNT Sleep and Health Research Lab

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Sleep seems such a simple thing. We've all done it since the day we were born. But if you can't remember the last time you got a good night's sleep, chances are you might be suffering from insomnia. You aren't alone.

About 30 percent of adults have occasional sleepless nights and about 18 percent suffer from chronic insomnia. Researchers with UNT's Sleep and Health Research Laboratory in the Department of Psychology want to find out why, learn the potential consequences and determine how to best help these weary individuals get some shut-eye.

Daniel Taylor, assistant professor of psychology, is in the final months of two studies that seek to answer these questions. The first is a one-year study of the prevalence of insomnia in college students, and the second is a two-year study that provides free cognitive behavior therapy to students who have difficulty sleeping.

"Insomnia is related to an overall decreased quality of life," says Taylor, who first became fascinated with insomnia research after reading an article in high school. "Individuals suffering from insomnia say it affects their relationships and work performance. Research also indicates these individuals have increased healthcare costs.

"Those suffering from insomnia generally just don't seem to enjoy life as much."

To help, Taylor and other researchers have looked to cognitive behavior therapy. This therapy focuses on changing a person's thoughts and behavior to resolve a problem. The therapy in Taylor's study aims to get students to change their thoughts about insomnia and its consequences and eliminate behaviors that make it worse.

Sabotaged sleep

UNT's sleep lab is among the few in the nation with a staff trained to help people conquer behaviors that sabotage their sleep. It also studies other sleep problems such as sleep apnea. Taylor says insomnia can start because of worry, depression, anxiety, pain or erratic sleep schedules.

Cases of insomnia seem to increase for people in their 20s and 30s (more women than men), then stabilize until about age 60, when they climb again. Taylor emphasizes cases "seem" to increase, because like much else with insomnia, most evidence comes from single point-in-time surveys rather than long-term studies.

Because it is difficult and expensive to track people over their lifetime, researchers like Taylor compare individuals in different age groups, who likely have different life experiences and illnesses that trigger insomnia. Once begun, insomnia often becomes chronic even when the original reason for sleepless nights has gone away. Sufferers start expecting not to sleep, which causes anxiety in itself. And to compensate, they may go to bed earlier when they wouldn't normally be tired.

"That just maintains it," Taylor says. "That's why we focus on changing the behavior and work to invalidate the myths people have about sleep."

Looking for a cause

UNT senior Lauren Cadahia, who went through the lab's six-week program in spring 2006, says she would "stress out" about her insomnia.

"I'd have trouble falling asleep, then I'd stress because I wasn't. It snowballed," she says. "The worry would prevent me from falling asleep."

Although insomnia's cause can be elusive, its definition is straightforward enough: taking longer than 30 minutes to fall asleep or waking for more than a half hour during the night for at least three nights a week in a six-month period.

That was just what Cadahia endured for four years. She felt "really tired and lethargic" and had difficulty concentrating in her classes, which, she adds, "had a very negative effect on my academics."

She'd nap in the afternoon to catch up on the sleep she'd missed the night before, sometimes not completing her homework as a result. Often she didn't have the energy to socialize. Yet, while everyone knows from their own occasional sleepless nights that Cadahia's experience is typical, Taylor notes that "the objective data doesn't hold up."

People report fatigue, he says, but there are no objective measures of low energy. On memory and continuous performance tasks, people with chronic insomnia score the same as those who fall asleep nearly instantly.

"It's very consistent that there is no difference between the two," Taylor says.

What apparently happens, he says, is that when it's necessary to do something, "you can generally pull your resources together" and do it just fine even when feeling tired. But Taylor suspects a study comparing individuals with insomnia after a good night's rest and after a sleepless night might show different results. The trick, he says, will be finding a way to record and measure the difference over time.

Searching for a cure

UNT's insomnia study treated adults and students during the 2006-07 academic year and is targeting only students this year. Taylor recruits students through flyers on campus. Those who qualify meet with a trained graduate student in clinical health psychology who administers a psychological and medical assessment to ascertain whether conditions such as bipolar disorder might be interfering with sleep.

Students then are monitored overnight in the sleep lab to rule out conditions like sleep apnea, which generally is caused by an obstruction of the airway or a disturbance in the brain's respiratory center, forcing the person to wake many times nightly to breathe.

If no medical causes can be found, students keep a sleep journal for a week to record their activity levels, possible depression, daytime sleepiness, anxiety levels and other measures.

At that point, they are randomly assigned either to receive immediate treatment or to be placed in a six-week control group to see if the problem evaporates on its own.

Treatment group students meet weekly for six weeks with a graduate-level psychotherapist who teaches relaxation skills, determines if the participant has any irrational fears and recommends healthy bedtime routines. (The control group receives treatment after the waiting period.)

Three months later, students fill out follow-up studies to check therapy effectiveness.

"All have improved," says Taylor of the students so far.

"But since it's an ongoing study, we haven't looked at the outcome data yet because it might insert bias."

He says the anecdotal evidence, however, shows that cognitive behavior therapy is "very effective."

It has been for Cadahia. After several weeks, she says, she was falling asleep in 20 minutes.

"That was huge for me," she says. "I started feeling much better, I focused better in class and I was more likely to get things done. I felt amazingly healthy."